Provider Demographics
NPI:1376642298
Name:SEATTLE EMERGENCY PHYSICIANS SERVICES INC PS
Entity Type:Organization
Organization Name:SEATTLE EMERGENCY PHYSICIANS SERVICES INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINNETTE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:JEFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-658-2488
Mailing Address - Street 1:747 BROADWAY
Mailing Address - Street 2:SWEDISH HOSPITAL EMERGENCY DEPARTMENT
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4379
Mailing Address - Country:US
Mailing Address - Phone:206-386-2573
Mailing Address - Fax:
Practice Address - Street 1:16410 84TH ST NE
Practice Address - Street 2:SUITE D-605
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-9060
Practice Address - Country:US
Practice Address - Phone:360-658-2488
Practice Address - Fax:877-501-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7007578Medicaid
WAG000171500Medicare PIN
WACS8918Medicare PIN